Bullying over health problems is common, according to two studies looking at kids with food allergies and those going through weight-loss programs.

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Two studies found that children with food allergies, or those seeking treatment for weight loss, reported bullying mainly by peers, including threatening the food-allergic kids with the allergen.

Note that the children who were victimized due to weight also reported parental bullying and continued bullying in school even after they lost weight.

Bullying over health issues is common, according to two studies looking at kids with food allergies and those going through weight-loss programs.

In one study, almost 32% of children with food allergies reported bullying or harassment specifically related to their allergy, often involving threats with food, Eyal Shemesh, MD, of Mount Sinai Medical Center in New York City, and colleagues found.

In a second study, 64% of teens at weight-loss camps reported weight-related victimization, not just by schoolmates but often by friends, coaches, teachers, and parents too, Rebecca Puhl, PhD, of Yale University, and colleagues reported.

Both studies appeared online in Pediatrics.

Because of the immediate and long-term physical and emotional effects, pediatricians and other clinicians should get involved in concrete ways, advised Mark Schuster, MD, PhD, of Boston Children's Hospital, and Laura Bogart, PhD, of Harvard Medical School in Boston, in an accompanying commentary.

They recommended anticipatory guidance for children and parents by describing bullying and its consequences and teaching parents how to recognize clues that it's occurring.

"In addition, clinicians can learn to recognize indicators of possible bullying such as unexplained bruises, cuts, and scratches, as well as school avoidance, social isolation, anxiety, depression, substance use, and chronic physical symptoms (e.g., headaches, stomachaches). They should be particularly alert when patients have stigmatizing characteristics that could lead to bullying (e.g., obesity, disabilities, gender nonconformity)."

Shemesh's group analyzed surveys of 251 established food allergy patients, ages 8 to 17, and their parents at a single allergy clinic in the Enhancing, Managing, and Promoting Well-Being and Resiliency program.

Any bullying or harassment of these children was reported by 45% of them and 36% of their parents, although with poor agreement when related to reasons other than the food allergy.

Being victimized due specifically to food allergies accounted for most of these cases, with 32% of the food allergic kids and about 25% of their parents reporting such bullying.

Almost all the bullies were classmates (80%), and most bullying happened at school (60%).

The most common form was teasing (42%), followed by waving the allergen in front of the child (30%).

Notably, 12% had been forced to touch the food they are allergic to and 10% had food thrown at them.

Bullying was significantly associated with poorer quality of life scores and greater anxiety, which the researchers noted was independent of allergy severity.

While most of the bullied kids said they had told someone about what happened, parents knew in only about half of the cases.

When parents did know, though, it was associated with better quality of life and less distress in the bullied children.

To increase disclosure of bullying, "clinicians might consider asking a screening question about bullying during encounters with children with food allergy," Shemesh's group suggested.

While it's hard to compare the results with those of other studies, general population rates appear to be 17% to 35%, suggesting that food-allergic children may be bullied or harassed more than their peers, they pointed out.

"This finding, although alarming, is not surprising, given that children with food allergies have a vulnerability that can be easily exploited," they wrote.

Puhl's study included 361 kids, ages 14 to 18, surveyed online while at two national weight-loss camps.

Notably, 34% of the respondents were in the normal weight range, while 24% were overweight and 40% were obese.

The large proportion of healthy-weight kids was unexpected, but "program administrators confirmed that a portion of enrollees had experienced significant weight loss and returned to camp for support with weight-loss maintenance."

The likelihood of weight-based victimization rose with weight, with odds ratios of 8.7 for overweight and 11.7 for obese kids, although those of a normal weight after weight-loss treatment still were at some risk.

The most common form was verbal teasing (75% to 88%), followed by relational victimization (74% to 82%), cyberbullying (59% to 61%), and physical aggression (33% to 61%).

The most common perpetrators were:

Peers: 92%

Friends: 70%

Physical education teachers or sport coaches: 42%

Parents: 37%

Teachers: 27%

While acknowledging that some of the adults may have been well-meaning, the researchers pointed out that this can still be extremely damaging.

"For those youth who are targets of weight-based victimization at school and at home, healthcare providers may be among their only remaining allies," they noted.

"Thus, it can be especially helpful for providers to promote adaptive coping strategies (e.g., positive self-talk, social support, problem-focused coping) during patient visits with youth who are targets of weight-based victimization."

Both groups of researchers acknowledged the limitation of self-reported data without independent verification or a control group and that their sample populations may not have been representative of the general population.

Puhl's study was supported by the Rudd Center for Food Policy and Obesity. Her group reported no conflicts of interest.

The Enhancing, Managing, and Promoting Well-being and Resiliency (EMPOWER) program and the analysis of it are supported by the Jaffe Family Foundation.

Shemesh reported research funding from the NIH National Institute of Diabetes and Digestive and Kidney Diseases and the Jaffe Family Foundation.

One of Shemesh's co-authors reported being a consultant for the Food Allergy Initiative and is an adviser for the Food Allergy and Anaphylaxis Network.

The commentary preparation was supported by an NIH grant. The commentators reported no conflicts of interest.

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